Path III Flashcards
esophageal varices are assoc with
portal HTN
alcoholics- cirrhosis
schistosomiasis mansoni or japonicum
presentation esophageal varices
asymptomatic then rupture and massive hematemesis
>30% fatality
what do esophageal varices look like on endoscopy
varices polypoid grape-like with cherry red spots
lye strictures
esophagitis
what infectious agents can cause esophagitis
candidiadis
herpesviruses
bacterial is uncommon
what is reflux esoophagitis
GERD
what does herpes esophagitis look like
punched out leasions, ulcers
intranuclear inclusions
clinical features GERD
> 40 y.o M>F obese>non-obese
mild and transient
heartburn, regurg, dysphagia
cough, chest pain
complications of GERD
esophageal ulceration
Barrett mucosa
stricture with stenosis
long-term risk of adenoca
most common cause gERD
loos tone of LES
histo of GERD
esosinophilia within squamous epithelium
elongation propria papillae and basal zone hyperplasia
What is NERD
non-erosive reflux disease,
no evidence of erosion
do not respond to PPIs
eosiniphilic esophagitis
failure high does PPI Tx in absence of acid reflux
atopic individuals
most important ADCA risk factor
barret esophagus, 30-40x increase if >3cm long
what reduces incidence ADCA in barrets esophagus
statins
what is a good stain for barrets esophagus
alcian blue stains the goblet cells
what are the benign tumors of esophagus
mesenchymal squamous papillomas (HPV related) inflammatory "pseudotumor"
malignant tumors of esophagus
adenocarcinoma, SCC
leiomyosarcoma and GI stromal tumor are less common
distribution of ADCA of esophagus
7M:1F
white>hispanic
prognosis of ADCA esophagus
<25% 5 yr survival from time of Dx
common place ADCA esophagus
distal third of esophagus
signs of ADCA esophagus
pain, dysphagia, progressive weight loss, hematemesis, chest pain, vomiting
histo ADCA esophagus? what stain?
holes with mucin in middle sometimes
mucicarmine stain
90% malignant esophageal tumors are what
SCC
risk factors SCC esophagus
heavy smoking and ethanol intake >50 y.o diet, achlasia, HPV, plummer vinson M4:1F blacks 8:1caucasians fermented milk- kenya
prognosis SCC esophagus
5 yr survival is <10%
most common place SCC esophagus
mid-esophagus
strictures, dysphagia, odynophagia, obstruction
what does histo SCC esophagus look like
keratin pearls
no mucin
what are the parts of stomach and cells in each area
superior to inferior
cardia- mucous cells fundus- parietal cells, chief cells body antrum- mucous cells, G cells pylorus
enterochromafin like cells in stomach secrete what
histamine
G cells secrete?
D cells secrete?
G cells- gastrin
D cells- somatostatin
chief cells secrete
pepsinogen and gastric lipase
functions of gastrin
stimulate parietal cells and chief cells
contract LES
increase stomach motility
relax pyloric sphincter
describe mucosa of stomach
superficial has specialized columnar cells
deeper has gastric puts with chief and parietal cells
where are blood vessels, lymph and nerves in stomach
submucosa
describe muscularis of stomach
outer zone for peristalsis: has outer longitudinal layer and internal circular layer
3rd layer of smooth muscle that is internal and oblique to the other layers
describe serosa of stomach
thin zone CT
single layer mesothelial cells
what is acute gastritis
acute mucosal inflammatory process of transient nature, Neutrophils present with or without ulceration
acute hemorrhagic gastritis is assoc with what
NSAIDs like aspirin
heavy alcohol intake
heavy smoking
stress
Tx stress gastric ulcers
PPIs
stress ulcers are common in what patients
shock, burns, sepsis, severe trauma
critically ill
what is gastropathy
repair process assoc with chronic episodes of acute gastritis
usually chemically induced
how do Dx gastropathy
clinical
no signs.. sometimes pain vomtiing, maybe blood
what cells are numerous in histo of acute gastritis
PMNs
what do stress uclers look like on gross structure
black because there is digested blood (Hb) on surface
what is chronic gastritis
presence of chronic mucosal inflammatory changes leading to atrophy and metaplasia usually in absence of erosions
chronic gastritis is usually secondary to what
H pylori
autoimmune gastritis is at increased risk for what
gastric cancer
transmission H pylor
oral-fecal route
gastritis assoc with H pylor attacks what part of stomach and patients at increase risk for what?
antrum
increased risk duodenal ulcer
4 features H pylor virulence
flagella
urease- generates ammonia to elevate gastric pH
adhesins
toxins like cytotoxin assoc gene A
What is hallmark of ongoign ifnection with H pylor
PMNs
what does chronic inflammation from H pylori look like on histo
diffuse lymphocytic infiltrate and plasma cells in lamina propria
presence of lymphoid follicles= severe
test for H pylor
swallow urea tagged with carbon 14 and then to breath test for C14
+ means H pylori present
